Relevant Codes for Mycamine® (micafungin sodium) for injection

Properly coding claims will help facilitate timely claims processing and reduce the risk of denied claims. Coding requirements vary by payer.1 The coding systems in the following tables will assist you in proper coding for Mycaminea:

Code Code Description Notes
00469-3250-10 50-mg single-use vial Carton of 10 individually packaged 50-mg single-use vials
00469-3211-10 100-mg single-use vial Carton of 10 individually packaged 100-mg single-use vials
Code Code Description
B37.7 Candidal sepsis
B37.81 Candidal esophagitis
B37.89 Other sites of candidiasis
Z48.290 Encounter for aftercare following bone marrow transplant
Z94.81 Bone marrow transplant status
Z94.84 Stem cells transplant status
Code Code Description
3E03029 Introduction of Other Anti-infective into Peripheral Vein, Open Approach
3E03329 Introduction of Other Anti-infective into Peripheral Vein, Percutaneous Approach
3E04029 Introduction of Other Anti-infective into Central Vein, Open Approach
3E04329 Introduction of Other Anti-infective into Central Vein, Percutaneous Approach
Code Code Description Notes
0250 Pharmacy-General Some payers, such as Medicare, require certain combinations of revenue codes and HCPCS or CPTb codes to facilitate claims processing. Confirm requirements with local payer policies
0260 IV Therapy-General
0636 Drugs requiring detailed coding
Code Code Description Notes
J2248 Injection, micafungin sodium, 1 mg This code represents a partial vial of micafungin sodium. Report the appropriate number of units based on amount of drug provided to the patient
Code Code Description Notes
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour Assign the appropriate code(s) for the service provided

a IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by Mycamine Support Solutions are to assist HCPs, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and information provided by Mycamine Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.

b Current Procedural Terminology (CPT), Professional Edition, 2016. American Medical Association, 2015. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.

References

1. Beck DE, Margolin DA. Physician coding requirement. Ochsner J. 2007;7:8-15.

2. Centers for Medicare & Medicaid Services. 2017 ICD-10-CM and GEMs. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. Accessed 12-07-2016.

3. Centers for Medicare & Medicaid Services. 2017 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html. Accessed 12-07-2016.

4. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending. Accessed 12-06-2016.